Sequence
Element
Name
Type
Requirement
Min
Max
Repeat
01
Adjustment Reason Code
Identifier (ID)
Mandatory
2
2
1
Code indicating reason for debit or credit memo or adjustment to invoice, debit
or credit memo, or payment
02
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
AD102 is the adjustment amount.
03
Adjustment Reason Code Characteristic
Identifier (ID)
Optional
1
2
1
Code specifying an additional characteristic of the adjustment reason
04
Frequency Code
Identifier (ID)
Optional
1
1
1
Code indicating frequency or type of activities or actions being reported
AD104 is frequency of the AD102 monetary amount.
05
Late Reason Code
Identifier (ID)
Optional
2
2
1
Code identifying the reason for tardiness